Higher versus lower oxygenation targets in adult ICU patients: A rapid practice guideline.
ICM-RPG
Intensive Care Medicine Rapid Practice Guideline
clinical practice guideline
oxygenation target
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
23 Dec 2023
23 Dec 2023
Historique:
revised:
17
11
2023
received:
17
10
2023
accepted:
01
12
2023
medline:
23
12
2023
pubmed:
23
12
2023
entrez:
23
12
2023
Statut:
aheadofprint
Résumé
The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) was to provide evidence-based clinical guidance about the use of higher versus lower oxygenation targets for adult patients in the intensive care unit (ICU). The guideline panel comprised 27 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines, including the use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and used the Evidence-to-Decision framework to generate recommendations. A recently published updated systematic review and meta-analysis constituted the evidence base. Through teleconferences and web-based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients' values and preferences, costs and resources, equity, feasibility, acceptability, and research priorities. The updated systematic review and meta-analysis included data from 17 randomized clinical trials with 10,248 participants. There was little to no difference between the use of higher versus lower oxygenation targets for all outcomes with available data, including all-cause mortality, serious adverse events, stroke, functional outcomes, cognition, and health-related quality of life (very low certainty of evidence). The panel felt that values and preferences, costs and resources, and equity favored the use of lower oxygenation targets. The ICM-RPG panel issued one conditional recommendation against the use of higher oxygenation targets: "We suggest against the routine use of higher oxygenation targets in adult ICU patients (conditional recommendation, very low certainty of evidence). Remark: an oxygenation target of SpO
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Acta Anaesthesiologica Scandinavica Foundation.
Références
Petersson J, Glenny RW. Gas exchange and ventilation-perfusion relationships in the lung. Eur Respir J. 2014;44:1023-1041.
Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P. Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care. 2015;5:42.
Schjørring OL, Klitgaard TL, Perner A, et al. Lower or higher oxygenation targets for acute hypoxemic respiratory failure. N Engl J Med. 2021;384:1301-1311.
Semler MW, Casey JD, Lloyd BD, et al. Oxygen-saturation targets for critically ill adults receiving mechanical ventilation. N Engl J Med. 2022;387:1759-1769.
Klitgaard TL, Schjørring OL, Nielsen FM, et al. Higher versus lower fractions of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit. Cochrane Database Syst Rev. 2023;9(9):CD012631. doi:10.1002/14651858.CD012631.pub3
Alhazzani W, Møller MH, Belley-Cote E, Citerio G. Intensive care medicine rapid practice guidelines (ICM-RPG): paving the road of the future. Intensive Care Med. 2019;45:1639-1641.
Laake JH, Astvad M, Bentsen G, et al. A policy for diversity, equity, inclusion and anti-racism in the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). Acta Anaesthesiol Scand. 2022;66:141-144. doi:10.1111/AAS.13978
Weiss B, Weiss B, Prisco L, et al. Statement paper on diversity for the European Society of Intensive Care Medicine (ESICM). Intensive Care Med. 2019;45:1002-1005.
Schünemann HJ, Wiercioch W, Brozek J, et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol. 2017;81:101-110.
Alhazzani W, Lewis K, Jaeschke R, et al. Conflicts of interest disclosure forms and management in critical care clinical practice guidelines. Intensive Care Med. 2018;44:1691-1698.
Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011;64:395-400.
Blackwood B, Ringrow S, Clarke M, et al. A core outcome set for critical care ventilation trials. Crit Care Med. 2019;47:1324-1331.
Crescioli E, Krejberg KU, Klitgaard TL, et al. Long-term effects of lower versus higher oxygenation levels in adult ICU patients-a systematic review. Acta Anaesthesiol Scand. 2022;66:910-922.
Hultcrantz M, Rind D, Akl EA, et al. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol. 2017;87:4-13.
Santesso N, Glenton C, Dahm P, et al. GRADE guidelines 26: informative statements to communicate the findings of systematic reviews of interventions. J Clin Epidemiol. 2020;119:126-135.
Asfar P, Schortgen F, Boisramé-Helms J, et al. Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial. Lancet Respir Med. 2017;5:180-190.
Barrot L, Asfar P, Mauny F, et al. Liberal or conservative oxygen therapy for acute respiratory distress syndrome. N Engl J Med. 2020;382:999-1008.
Gelissen H, de Grooth H-J, Smulders Y, et al. Effect of low-normal vs high-normal oxygenation targets on organ dysfunction in critically ill patients: a randomized clinical trial. JAMA. 2021;326:940-948.
Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA. 2016;316:1583-1589.
Gomersall CD, Joynt GM, Freebairn RC, Lai CKW, Oh TE. Oxygen therapy for hypercapnic patients with chronic obstructive pulmonary disease and acute respiratory failure: a randomized, controlled pilot study. Crit Care Med. 2002;30:113-116.
Jakkula P, Reinikainen M, Hästbacka J, et al. Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial. Intensive Care Med. 2018;44:2112-2121.
Jun J, Sun L, Wang Y, Liu F, Yang G, Han B. Invasive mechanical ventilation with high concentration oxygen therapy for AECOPD patients with acute myocardial infarction. Chest. 2019;156:A958.
Lång M, Skrifvars MB, Siironen J, et al. A pilot study of hyperoxemia on neurological injury, inflammation and oxidative stress. Acta Anaesthesiol Scand. 2018;62:801-810.
Conservative oxygen therapy during mechanical ventilation in the ICU. N Engl J Med. 2020;382:989-998.
Martin DS, McNeil M, Brew-Graves C, et al. A feasibility randomised controlled trial of targeted oxygen therapy in mechanically ventilated critically ill patients. J Intensive Care Soc. 2021;22:280-287.
Mazdeh M, Taher A, Torabian S, Seifirad S. Effects of normobaric hyperoxia in severe acute stroke: a randomized controlled clinical trial study. Acta Med Iran. 2015;53:676-680.
Panwar R, Hardie M, Bellomo R, et al. Conservative versus liberal oxygenation targets for mechanically ventilated patients. A pilot multicenter randomized controlled trial. Am J Respir Crit Care Med. 2016;193:43-51.
Schmidt H, Kjaergaard J, Hassager C, et al. Oxygen targets in comatose survivors of cardiac arrest. N Engl J Med. 2022;387:1467-1476.
Yang X, Shang Y, Yuan S. Low versus high pulse oxygen saturation directed oxygen therapy in critically ill patients: a randomized controlled pilot study. J Thorac Dis. 2019;11:4234-4240.
Yang W, Zhang L. Observation of the curative effect of conservative oxygen therapy in mechanical ventilation of patients with severe pneumonia. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021;33:1069-1073.
Halling C. EE279 Cost-Utility Analysis of Lower or Higher Oxygenation Targets for Acute Hypoxaemic Respiratory Failure-A Registry-Based Secondary Analysis of the Randomised Hot-ICU Trial. 2023.
Ross M, Wendel SK. Oxygen inequity in the COVID-19 pandemic and beyond. Glob Health Sci Pract. 2023;11:e2200360.
Mer M, Aryal D, Nielsen ND, et al. Critical care pandemic preparation: considerations and lessons learned from COVID-19. Crit Care Clin. 2022;38:761-774.
Usher AD. Medical oxygen crisis: a belated COVID-19 response. Lancet. 2021;397:868-869.
Sutherland T, Musafiri S, Twagirumugabe T, Talmor D, Riviello ED. Oxygen as an essential medicine: under- and over-treatment of hypoxemia in low- and high-income nations. Crit Care Med. 2016;44:e1015-e1016.
Blanchet M-A, Mercier G, Delobel A, et al. Accuracy of multiple pulse oximeters in stable critically ill patients. Respir Care. 2023;68:565-574.
Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial bias in pulse oximetry measurement. N Engl J Med. 2020;383:2477-2478.
Young PJ, Arabi YM, Bagshaw SM, et al. Protocol and statistical analysis plan for the mega randomised registry trial research program comparing conservative versus liberal oxygenation targets in adults receiving unplanned invasive mechanical ventilation in the ICU (Mega-ROX). Crit Care Resusc. 2022;24:137-149.
van der Wal LI, Grim CCA, del Prado MR, et al. Conservative versus liberal oxygenation targets in intensive care unit patients (ICONIC): a randomized clinical trial. Am J Respir Crit Care Med. 2023;208:770-779. doi:10.1164/rccm.202303-0560OC